- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,882.75 / $13,074.20 / $21,706.20
| Facility | | $8,882.75 | $13,074.20 | $21,706.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,988.00 / $2,988.00 / $12,896.10
| Facility | | $2,988.00 | $2,988.00 | $12,896.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,064.32 / $12,345.19 / $20,918.59
| Facility | | $8,064.32 | $12,345.19 | $20,918.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,269.53 / $14,291.48 / $24,960.20
| Facility | | $11,269.53 | $14,291.48 | $24,960.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,005.63 / $14,000.04 / $36,060.44
| Facility | | $7,005.63 | $14,000.04 | $36,060.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,005.63 / $13,366.73 / $18,786.28
| Facility | | $7,005.63 | $13,366.73 | $18,786.28 |